In 2014 it was estimated that thre were 72.7 million adults with a disability in the United States and the most common disability domain was physical disability (Taylor, 2018). In addition to functional limitations associated with physical disability, people with physical disabilities, as well as people with other kinds of disabilities, are more likely than those without disabilities to report poorer overall health and less access to health care. (Centers for Disease Control and Prevention, 2018). Further, physical disability may place people at greater risk for developing chronic conditions and poor health (Horner-Johnson, et. al., 2013).
There are many potential health problems associated with physical disabilities such as bowel or bladder problems, fatigue, injury, poor mental health and depression, overweight status and obesity, pain, and pressure sores or ulcers (Centers for Disease Control and Prevention, 2018). These health problems are associated with lower health-related quality of life, and can lead to reduced community participation, increased health care use, and lower levels of employment (Rimmer, Chen, Hsieh, 2011). These potential health problems must be managed to minimize negative effects. There is a need to better understand how specific health problems are interrelated with health and function among people with physical disabilities; how they may affect community participation, work productivity, and quality of life; and how they may be prevented or mitigated (Rimmer, Chen, Hsieh, 2011; Centers for Disease Control and Prevention, 2013).
Furthermore, adults with disabilities experience significant disparities in health and health care access and utilization relative to those without disability (Pharr& Bungum, 2012; Reichard, Stolzle, & Fox, 2011; Havercamp & Scott, 2015). Reasons cited for these disparities include lack of health insurance or coverage for necessary services, such as specialty care, long-term care, care coordination, prescription medications, durable medical equipment, and assistive technologies. Additional factors include limited accessibility at medical facilities, lack of examination equipment and individualized accommodations that can be used by people with diverse disabilities, and the absence of professional training on disability competency for healthcare practitioners (National Council for Disabilities, 2009).
NIDILRR has funded a wide range of research related to the health and function outcomes of people with disabilities. As described in NIDILRR's Long-Range Plan for 2018-2023 (NIDILRR, 2019), maximizing health and function is critical to people with disabilities, and for their general well-being and their fulfillment of personal aspirations in areas such as employment and community participation. Maximizing health and function of people with disabilities will require the development of new and improved rehabilitation strategies, as well as the refinement of policies, programs, practices, and technologies that reduce functional limitations and improve health outcomes. In accordance with our Long Range Plan, NIDILRR seeks to build on prior investments in health and function research for people with physical disabilities, by supporting innovative and well-designed research and training projects that address these critical needs.
Centers for Disease Control and Prevention (2013). Healthy People 2020: Disability and Health. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?to….
Centers for Disease Control and Prevention (2018). Disability and Health: Related Conditions. Retrieved from http://www.cdc.gov/ncbddd/disabilityandhealth/relatedconditions.html.
Havercamp, S. M., & Scott, H. M. (2015). National health surveillance of adults with disabilities, adults with intellectual and developmental disabilities, and adults with no disabilities. Disability and Health Journal, 8(2), 165-172.
Horner-Johnson, W., Dobbertin, K., Lee, J. C., Andresen, E. M., & the Expert Panel on Disability and Health Disparities (2013). Disparities in chronic conditions and health status by type of disability. Disability and Health Journal, 6(4), 280–286.
National Council on Disability (2009). The Current State of Health Care for People with Disabilities. National Council on Disability. Washington, DC. Retrieved from www.ncd.gov/publications/2009/Sept302009.
National Institute on Disability, Independent Living, and Rehabilitation Research (2019). 2018-2023 Long-Range Plan. Retrieved from https://acl.gov/sites/default/files/about-acl/2019-01/NIDILRR%20LRP-201….
Pharr, J. R., & Bungum, T. (2012). Health Disparities Experienced by People with Disabilities in the United States. Global Journal of Health Science, 4(6), 99-108.
Reichard, A., Stolzle, H., & Fox, M. H. (2011). Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disability and Health Journal, 4(2), 59-67.
Rimmer, J.H., Chen, M., Hsieh, K. (2011) . A Conceptual Model for Identifying, Preventing, and Managing Secondary Conditions in People with Disabilities. Physical Therapy, 91(12), 1728-1739.
Taylor, D. M. (2018). Americans with Disabilities: 2014, Current Population Reports (P70-152). U.S. Census Bureau, Washington, DC, 2018. U.S. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/dem….
Priority--RRTC on Health and Function of People with Physical Disabilities
The Administrator of the Administration for Community Living (ACL) establishes a priority for an RRTC on Health and Function of People with Physical Disabilities.
The RRTC must contribute to maximizing the health and function outcomes of people with physical disabilities by:
(a) Conducting research activities in one or more of the following priority areas, focusing on people with physical disabilities as a group or on people in specific physical disability or demographic subpopulations:
(i) Technology to improve health and function outcomes for people with physical disabilities.
(ii) Individual and environmental factors associated with improved access to rehabilitation and health care and improved health and function outcomes for people with physical disabilities.
(iii) Interventions that contribute to improved health and function outcomes for people with physical disabilities. Interventions include any strategy, practice, program, policy, or tool that, when implemented as intended, contributes to improvements in outcomes for the specified population.
(iv) Practices and policies that contribute to improved health and function outcomes for people with physical disabilities.
(v) Effects of government practices, policies, and programs on health care access and on health and function outcomes for people with physical disabilities.
(b) Serving as a national resource center related to health and function of people with physical disabilities, their families, and other stakeholders by conducting knowledge translation activities that include, but are not limited to:
(i) Providing information and technical assistance to service providers, people with physical disabilities and their representatives, and other key stakeholders.
(ii) Providing training, including graduate, pre-service, and in-service training, to rehabilitation providers and other disability service providers, to facilitate more effective delivery of services to people with physical disabilities. This training may be provided through conferences, workshops, public education programs, in-service training programs, and similar activities.
(iii) Disseminating research-based information and materials related to health and function of people with physical disabilities. The applicant must provide, as part of its application, a plan to disseminate its research results to people with disabilities and their representatives, disability organizations, service providers, professional journals, manufacturers, and other interested parties.
(iv) Involving relevant stakeholder groups in the activities conducted under paragraph (a) in order to maximize the relevance and usability of the new knowledge generated by the RRTC.
For research conducted under paragraph (a), the RRTC must focus its research activities on a specific stage of research and clearly specify the stage in its application. If the RRTC is to conduct research that can be categorized under more than one stage, including research activities that progress from one stage to another, those stages must be clearly specified and justified. These stages – exploration and discovery, intervention development, intervention efficacy, and scale-up evaluation – are defined in this funding opportunity announcement.
If an application is funded, the grantee may consult with the NIDILRR-funded Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) on implementation of the dissemination plan described in (b)(iii).
General Rehabilitation Research and Training Center Requirements
The effectiveness of any RRTC depends on, among other things, how well the RRTC coordinates its research efforts with the research of other NIDILRR-funded projects, and involves individuals with disabilities in its activities. Accordingly, the RRTC must:
(a) Coordinate on research projects of mutual interest with relevant NIDILRR-funded projects as identified by the NIDILRR Project Officer.
(b) Involve people with disabilities, including individuals with disabilities from minority backgrounds, in planning and implementing its research, training, and dissemination activities, and in evaluating the RRTC.
(c) Coordinate with the appropriate NIDILRR-funded Knowledge Translation Centers and professional and consumer organizations to provide scientific results and information to policymakers, service providers, researchers, and others, including employers, vocational rehabilitation providers, and independent living centers.
Definitions - Stages of Research:
Exploration and discovery means the stage of research that generates hypotheses or theories through new and refined analyses of data, producing observational findings and creating other sources of research-based information. This research stage may include identifying or describing the barriers to and facilitators of improved outcomes of individuals with disabilities, as well as identifying or describing existing practices, programs, or policies that are associated with important aspects of the lives of individuals with disabilities. Results achieved under this stage of research may inform the development of interventions or lead to evaluations of interventions or policies. The results of the exploration and discovery stage of research may also be used to inform decisions or priorities.
Intervention development means the stage of research that focuses on generating and testing interventions that have the potential to improve outcomes for individuals with disabilities. Intervention development involves determining the active components of possible interventions, developing measures that would be required to illustrate outcomes, specifying target populations, conducting field tests, and assessing the feasibility of conducting a well-designed intervention study. Results from this stage of research may be used to inform the design of a study to test the efficacy of an intervention.
Intervention efficacy means the stage of research during which a project evaluates and tests whether an intervention is feasible, practical, and has the potential to yield positive outcomes for individuals with disabilities. Efficacy research may assess the strength of the relationships between an intervention and outcomes and may identify factors or individual characteristics that affect the relationship between the intervention and outcomes. Efficacy research can inform decisions about whether there is sufficient evidence to support “scaling-up” an intervention to other sites and contexts. This stage of research may include assessing the training needed for wide-scale implementation of the intervention and approaches to evaluation of the intervention in real-world applications.
Scale-up evaluation means the stage of research during which a project analyzes whether an intervention is effective in producing improved outcomes for individuals with disabilities when implemented in a real-world setting. During this stage of research, a project tests the outcomes of an evidence-based intervention in different settings. The project examines the challenges to successful replication of the intervention and the circumstances and activities that contribute to successful adoption of the intervention in real-world settings. This stage of research may also include well-designed studies of an intervention that has been widely adopted in practice, but lacks a sufficient evidence base to demonstrate its effectiveness.